Chronic Kidney Disease is increasing at incredible numbers. When should dialysis be started? Some centers prefer it early and others late. A study published online on Nov 8, 2010 by Arch Intern Med indicates that early start of hemodialysis could in fact be harmful, increasing the hazard ratio.

    A sudden increase in the "early start" of dialysis with an estimated glomerular filtration rate (eGFR) at least 10 mL/min/1.73 m2 has occurred in the United States since at least 1996. Several recent studies have reported a co morbidity-adjusted survival disadvantage of early start of dialysis, but the current study checks a relatively healthy dialysis cohort.

    The team under Steven J. Rosansky examined demographics, year of dialysis initiation, serum albumin etc in 81,176 non diabetic, 20-64 year old, in-centre incident hemodialysis patients with no reported co morbidity besides hypertension. Survival was compared using a piecewise proportional hazards model to estimate covariate-adjusted mortality hazard ratios (HRs) for eGFR at the time of initiation of dialysis. Time-dependent adjusted analysis stratified by initial serum albumin levels lower than 2.5 g/dL, 2.5 to 3.49 g/dL, and 3.5 g/dL or higher (the "healthiest" group [HG])was also performed.

    Unadjusted 1-year mortality by eGFR ranged from 6.8% in the reference group (eGFR <5.0 mL/min/1.73 m2) to 20.1% in the highest eGFR group ( 15.0 mL/min/1.73 m2). Compared with the reference group, the HR for the HG was 1.27 (eGFR, 5.0-9.9 mL/min/1.73 m2), 1.53 (eGFR, 10.0-14.9 mL/min/1.73 m2), and 2.18 (eGFR 15.0 mL/min/1.73 m2) and ranged from 1.50 to 3.53 mL/min/1.73 m2 in the first year of dialysis for the early-start group.

    The increased hazard ratio indicates that early start of dialysis may be harmful.